Allergic Rhinitis (Allergies)

Last Updated August 2022 | This article was created by familydoctor.org editorial staff and reviewed by Leisa Bailey, MD

What is allergic rhinitis?

Allergic rhinitis is the medical term for hay fever or nasal allergies. By definition, allergic rhinitis is swelling of the nasal passages caused by allergens. It’s important to note that while many people refer to it as hay fever, it is not caused by hay. Nor does is cause a fever. Allergic rhinitis is triggered by having allergies. You have an allergy when your body overreacts to things that don’t cause problems for most people. These things are called allergens.

There are 2 forms of allergic rhinitis:

  • Seasonal (hay fever):Caused by an allergy to pollen and/or mold spores in the air. Pollen is the fine powder that comes from flowering plants. It can be carried through the air and is easily inhaled. Symptoms are seasonal and usually occur in spring, late summer, and fall. This is the most common form of allergy.
  • Perennial:Caused by other allergens such as dust mites, pet hair or dander, or mold. Symptoms occur year-round.

Symptoms of allergic rhinitis

Your symptoms can vary, depending on the severity of your allergies. Symptoms can include:

  • Sneezing
  • Coughing
  • Itching (mostly eyes, nose, mouth, throat and skin)
  • Runny nose
  • Stuffy nose
  • Headache
  • Pressure in the nose and cheeks
  • Ear fullness and popping
  • Sore throat
  • Watery, red, or swollen eyes
  • Dark circles under your eyes
  • Trouble smelling

Allergic rhinitis can last several weeks, longer than a cold or the flu. It does not cause fever. The nasal discharge is thin, watery, and clear. Nasal discharge from a cold or the flu tends to be thicker. Itching (mostly in the eyes, nose, mouth, throat, and skin) is common with hay fever but not with a cold or the flu. Sneezing occurs more with hay fever. You may even have severe sneeze attacks.

What causes allergic rhinitis?

If you have allergies, your body releases chemicals when you are exposed to an allergen. One such chemical is called histamine. Histamine is your body’s defense against the allergen. The release of histamine causes your symptoms.

Hay fever is an allergic reaction to pollen. Pollen comes from flowering trees, grass, and weeds. If you are allergic to pollen, you will notice your symptoms are worse on hot, dry days when wind carries the pollen. On rainy days, pollen often is washed to the ground, which means you are less likely to breathe it. Your allergies can vary depending on the time of year:

  • Allergies that occur in the spring (late April and May) are often due to tree pollen.
  • Allergies that occur in the summer (late May to mid-July) are often due to grass and weed pollen.
  • Allergies that occur in the fall (late August to the first frost) are often due to ragweed.

Allergens that can cause perennial allergic rhinitis include:

  • Mold is common where water tends to collect, such as shower curtains and damp basements. It can also be found in rotting logs, hay, and mulch. This allergy is usually worse during humid and rainy weather.
  • Animal dander.The skin, saliva, and urine of furry pets such as cats and dogs are allergens. You can be exposed to dander when handling an animal or from house dust that contains dander.
  • Many allergens, including dust mites, are in dust. Dust mites are tiny living creatures found in bedding, mattresses, carpeting, and upholstered furniture. They live on dead skin cells and other things found in house dust.

How is allergic rhinitis diagnosed?

If your symptoms interfere with your daily life, see your family doctor. Your doctor will ask you questions about your symptoms and medical history and perform a physical exam. Keeping a record of your symptoms over a period of time can help your doctor determine what triggers your allergies.

Your doctor may want to do an allergy skin test to determine what you are allergic to. Tiny amounts of allergens are applied to your skin. You will feel tiny pricks that are usually not painful. Your doctor will observe and record the way your skin reacts to each allergen.

Your doctor may also decide to do a blood test, such as the radioallergosorbent test (RAST). This test identifies antibodies in your blood that determine what you’re allergic to. Once your allergens are identified, you and your doctor can decide the best treatment.

Can allergic rhinitis be prevented or avoided?

Allergic rhinitis cannot be prevented. You can help your symptoms by avoiding the things that cause your symptoms.

  • Keep windows closed. This is especially important during high-pollen seasons.
  • Wash your hands after petting animals.
  • Use dust- and mite-proof bedding and mattress covers.
  • Wear glasses outside to protect your eyes.
  • Shower before bed to wash off allergens from hair and skin.

You can also avoid things that can make your symptoms worse, such as:

  • Aerosol sprays
  • Air pollution
  • Cold temperatures
  • Humidity
  • Irritating fumes
  • Tobacco smoke
  • Wind
  • Wood smoke

Allergic rhinitis treatment

Several medicines can be used to treat allergies. Nasal steroids are often the most effective treatment. Your doctor will help you determine what medicine is best for you depending on your symptoms, age, and overall health. If you are pregnant, your doctor will advise what medications are safe for you to take. Some allergy symptoms during pregnancy are a naturally occurring part of being pregnant and not allergic rhinitis.

These medicines help prevent symptoms if you use them regularly, before you’re exposed to allergens:

  • Nasal steroid spraysreduce the reaction of the nasal tissues to inhaled allergens. This helps relieve the swelling in your nose so that you feel less stopped-up. They are the most effective at treating patients who have chronic symptoms. Many nasal steroids are now available without a prescription. You won’t notice their benefits for up to 2 weeks after starting them.
  • Antihistamineshelp reduce the sneezing, runny nose, and itchiness of allergies. These come in pill form and as nasal sprays. Many are available over the counter. Some require a prescription.
  • Decongestants, such as pseudoephedrine and phenylephrine, temporarily relieve the stuffy nose of allergies. Decongestants are found in many medicines and come as pills, nose sprays, and nose drops. They are best used only for a short time. Nose sprays and drops shouldn’t be used for more than 3 days because you can become dependent on them. This causes you to feel even more stopped-up when you try to quit using them. You can buy decongestants without a doctor’s prescription. However, they can raise your blood pressure. Talk your family doctor before using them if you have high blood pressure.
  • Leukotriene inhibitors are prescription pills that help block leukotrienes. Leukotrienes are another class of chemicals that the body releases when exposed to allergens.
  • Cromolyn sodiumis a nasal spray that helps prevent the body’s reaction to allergens. This medicine may take 2 to 4 weeks to start working. It is available without a prescription.
  • Eye drops. If your other medicines are not helping enough with your itchy, watery eyes, your doctor may prescribe eye drops for you. Some are available over the counter.
  • Allergy shots or sublingual tablets(also called immunotherapy) are an option for people who try other treatments but still have allergy symptoms. These shots or dissolvable tablets contain a very small amount of the allergen you are allergic to. They’re given on a regular schedule so that your body gets used to the allergens. This helps decrease your body’s sensitivity to the allergens. Over time, your allergy symptoms will become less severe.

Living with allergic rhinitis

Living with the symptoms of allergic rhinitis can affect your daily life. Nasal symptoms can be worse when lying down. This can disturb your ability to sleep well. Fatigue and headaches can affect your ability to function at school and work.

There is also a link between asthma, eczema, and allergic rhinitis. Therefore, getting good control of allergic rhinitis is crucial for maintaining good control of asthma.

There are many medicines and treatments that can help you manage your symptoms. Talk to your doctor as soon as you feel that your symptoms are getting worse or are not easy to control. Your doctor can help you come up with the right plan to control allergies so they don’t affect your ability to live your normal life.

Questions to ask your doctor

  • Could anything else, such as a cold or the flu, be causing my symptoms?
  • How do I figure out what I’m allergic to?
  • Is my allergy seasonal?
  • I am allergic to _____. Am I at risk for any other allergies?
  • What changes can I make at home to relieve my symptoms?
  • Will any over-the counter medicines relieve my symptoms?
  • What should I do if my symptoms get worse or don’t respond to the treatment you’ve prescribed?
  • Do I need to see an allergy specialist (called an allergist or immunologist)?